ABEA027 - Interventions And Outcomes In Posterior Glottic Versus Multi-level Airway Stenosis: A Multi-institutional Review
Saturday, April 30, 2022
8:39 AM – 8:45 AM CT
Location: Landmark D
VyVy N Young, Grant E. Gochman, Shambavi Rao, Anastasiya Stasyuk, Kychelle L. Del Rosario, Daniel J Cates, Lyndsay L. Madden
UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA; Wake Forest School of Medicine, Winston Salem, NC; University of California Davis School of Medicine, Sacramento, CA; UC Davis Center for Voice & Swallowing, Department of Otolaryngology - Head & Neck Surgery, University of California Davis, Sacramento, CA; Wake Forest Voice and Swallowing Center, Department of Otolaryngology-Head & Neck Surgery, Wake Forest School of Medicine, Winston Salem, NC
Associate Professor UCSF Voice and Swallowing Center University of California, San Francisco San Francisco, California
Objectives: Airway stenosis - particularly multi-level - presents complex management challenges. We assessed tracheostomy and decannulation rates and number of surgeries required in patients with posterior glottic stenosis (PGS), multi-level airway stenosis (MLAS), and bilateral vocal fold paralysis (BVFP).
Methods: Three tertiary laryngology centers retrospectively identified airway stenosis patients treated between 2019-present. Demographics, etiology, medical co-morbidities, type and timing of surgeries, and patient reported outcome measures (PROMs) were collected. Statistical analyses included Fisher’s exact and t-tests.
Results: 65 patients (40 women, mean age 54+/-15 years) were identified (22 PGS, 23 MLAS, 20 BVFP). 60% required tracheostomy, including 59.1%, 73.9%, and 45% in PGS, MLAS, and BVFP, respectively. Decannulation rates were 46.2%, 35.3% and 44.4%, respectively. Rates of tracheostomy and decannulation were not different between groups (p>0.05). MLAS required more surgery (mean 3.4+/-3.4) than PGS (1.6+/-1.8, p=0.0377) or BVFP (1.0+/-1.7, p=0.0068). Surgeries commonly involved transverse cordotomy (16.8%), laser excision/balloon dilation (8%), combined transverse cordotomy/arytenoidectomy (7.3%) and balloon dilation/steroids or granulation tissue excision (6.6% each). Mean PROMs at presentation and latest follow-up were 21.7+/-12.2 and 17.2+/-12.2 respectively (Dyspnea Index), 24.4+/-12.3 and 20.4+/-13.1 (Voice Handicap Index-10), and 11.7+/-11.2 and 10.0+/-11.2 (Eating Assessment Tool-10). Co-morbidities included BMI>30 (42%), diabetes (29%), pulmonary disease (38%), GERD (40%), autoimmune disease (12%), and tobacco use history (48%).
Conclusions: Management of airway stenosis is challenging, negatively impacting quality of life and requiring numerous surgeries. PGS more frequently requires tracheostomy compared to BVFP but patients can often decannulate successfully. Patients with multi-level stenosis have lower decannulation rates and require more surgeries than glottic stenosis alone; these patients would benefit from earlier and/or more aggressive intervention.